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Home My Public Portal About10511 FREER ST_Mechanical__ • 76 A364-.CE 816- 6-73 APPNCATION F4;;kERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES 7NEAREST DEPARTMENT OF COUNTY ENGINEER ©�� gee e., S BUILDING AND SAFETY DIVISION f A�f r q- e e FOR APPLICANT TO FILL IN ` (PRINT OR TYPE ONLY) c9 G'ALL74 MAI IL No TYPE OF APPLIANCE OREQUIPMEN_T - FEE ADDRESS a.s I Ree P_ J CITY of /P TEL. NO. 738 ABSORPTION UNIT, BTU CONTRACTOR �e AIR HANDLING UNIT, CFM ADDRESS BOILER, BTU CITY TEL. NO. COMPF ESSOR, BTU STATE LIC. LICENSE NO. CLASS VENTILATION SYSTEM DISTRICT NO. GROUPZON PROC SSED BY J I EVAPORATIVE COOLER Lti-p FURNACE: FAU GRAVITY FLOOR BTU INSPECTION RECORD QD HEATER: SUSPENDED UNIT_ WALL a O Y V C) F_ V • W, . a- (n Plan check fee 25% of above. See reverse. z PERi41T ISSUING FEE 3 3 00 TOTAL, FEE PLAN CHECK APPLICANT NAME ADDRESS CITY TEL.NO. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECT SIGNATURE LATING, AIR CONDITIONING. - �/ Z 1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION 7 ROUGH OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONALFINAL —W07 � -� CODE OF THE STATE OF rIF RNIA SIGNATURE �Id OF PERMITTEE PERMIT VALIDATION C M.O. CASH r - PLAN CHECK VALIDATION CK. M.O. CASH 1,.0.9 N DEC 12 4.1 © 8'.0.0 09 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKER'S COMPENSATION ate of consent to 76A346DPW9/89 APPLICATION FOR PERMIT LimE GREEN I I,hereby.affirm Jhat Ihave acertificate of consent to self insure, 76A364C i or,a,ce[tificate of�Worker's•Compensation Insurance, or a certified HEATING -VENTILATING .AIR CONDITIONING t. copy thereof(Sec 3600 Lab C) ' 'Policy No •Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. F-1. Certified copy is hereby furnished. : E], Certrfied'copy Is tiled with the county building inspection' FOR APPLICANT TO FILL IN BUILDING department. (PRINT OR TYPE ONLY) ADDRESS (Os FIZ7tR Date Applicant LOCALITYNO. TYPE OF APPLIANCE OR EQUIPMENT, FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST COMPENSATION INSURANCE - ABSORPTION UNIT,BTU ASSESSOR (This section need not'be completed if the work involved by the MAP BOOK �1 '! PAGE[Zp/ PARCEtO'%� permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,-CFM DISTRICT No PRocesseD BY I certify'that in the,performance of the work for which this permit Is issued'=I•shall,not employ any person in any manner so as to BOILER,BTU became subtect to the Workers' Compensation Laws. COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making 'this Certificate of ROUGH Exemption,you should become"subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you"must forthwith comply with such FINAL r y provisions or this permit shall be deemed revoked. FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR B-rU ;VALIDATION I hereby affirm that I'am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and / HEATER WALL �� Q Professions Code, and my license is in full force and effect. 'License Number Lic.Class r.i..� f�r•1104 _ , a i Contractor Date - V ❑1 •; • _1.`moi_ s�l O [.am exempt under Sec. Plan Check fee— _ ' B&P C.for this reason PERMIT ISSUING FEE $ Q _; i � �r #^� O i Date: i OTAL -_� 2 a 4 1i . V TOTAL FEE d0c'' t. �11 ._li I W Signature' `'. PLAN CHECK APPLICANT, ,�I�1� Z OWNER-BUILDER DECLARATION r_;(aA [LiF I hereby affirm that I am exempt from the Contractor's License Law NAME , for the following reason.(Section 7031.5, Busiriess'and Professions ADDRESS UE li f—j I`j�j +`L t I, as owner of the property, or my employees with wages t as their sole compensation, will do the work and the CITY TEL.NO 4225 Hil�� structure is not intended or offered for sale (Section 7044, Business and Professions Code) OWNER Rp��/� L� ❑ • 'I, as owner.of the property, am exclusively contracting MAIL with licensed contractors to construct the protect (Sec- ADDRESS ' o 1-4 l � J � tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY Gy TEL NOG ' -� -p hereby affirm-that there is a construction lending agency for CONTRACTOR L'T the performance of the work for-which this permit is issued (Sec 3097, Civ.C.). ADDRESS , Lender's Name CITY TEL.NO. Lender's Address [LICENSE TATE, LIC.' 'I certify that I have read this application and state that•the above NO CLASS information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned. property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ,R\NATURE OF APPLICANT OR AGENT DATE -